British Journal of Sports Medicine

Correction: Prenatal exercise (including but not limited to pelvic floor muscle training) and urinary incontinence during and following pregnancy: a systematic review and meta-analysis

17-02-2020 –

Davenport MH, Nagpal TS, Mottola M, et al. Prenatal exercise (including but not limited to pelvic floor muscle training) and urinary incontinence during and following pregnancy: a systematic review and meta-analysis. Br J Sports Med 2018;52:1397-1404. doi:10.1136/bjsports-2018-099780.
Professor Dumoulin felt her attribution was incorrect in the published paper and agreed that she should no longer be acknowledged.
The acknowledgement section should therefore read:The authors wish to acknowledge Mary Duggan from the Canadian Society for Exercise Physiology who is the primary knowledge use for the Canadian Institute of Health Research Knowledge Synthesis Grant. The authors also wish to thank Anne Courbalay and Baily Shandro for their assistance with the systematic review and Meghan Sebastianski from the Alberta SPOR SUPPORT Unit Knowledge Translation Platform, University of Alberta for her assistance with the meta-analysis.

Celebrating sports physiotherapy specialist: kudos Jacinta Horan (SEPNZ)

17-02-2020 – Jarratt, B.

Specialisation – the process of becoming an expert in a particular area of work, study or business; the fact of spending more time on one area of work. Oxford dictionary Making history For the field of sports medicine, 2019 will stand in the history of New Zealand (NZ) physiotherapy. When the NZ Board of Physiotherapy first released the areas of specialisation, the category ‘sports’ was left off the list. Some argued that sports should sit under the musculoskeletal specialisation area and there would be no need for a stand-alone category. At that time, the leaders of Sport and Exercise New Zealand (SEPNZ) stood up for all sports practitioners and argued that in its own right it should be recognised as its area of specialisation. Over the years, NZ has watched as other categories of practice gained specialist physiotherapists. In August 2019, the number of specialist physiotherapists was…

Three steps to changing the narrative about knee osteoarthritis care: a call to action

17-02-2020 – “Caneiro, J., OSullivan, P. B., Roos, E. M., Smith, A. J., Choong, P., Dowsey, M., Hunter, D. J., Kemp, J., Rodriguez, J., Lohmander, S., Bunzli, S., Barton, C. J.”


Knee osteoarthritis (OA), characterised by knee pain and functional limitation,1 2 is widely understood to imply that symptoms are due to structural damage. This view leads to the belief that non-surgical approaches are futile and the structural damage needs to be ‘fixed’.3 4 In contrast, contemporary evidence supports knee OA as a ‘whole person condition’ in which knee health is influenced by the interaction of different biopsychosocial factors that modulate inflammatory processes and tissue sensitivity, as well as behavioural responses that lead to pain and disability.5 6 This contrasting view reinforces the critical role of non-surgical approaches to manage knee OA. To promote this conceptual shift in understanding knee OA, clinicians must take three key actions. Change the message Clinicians must explain that knee pain is a modifiable symptom related to sensitised knee structures and influenced…

Its not them, its you. Dodge the despair and disseminate your work effectively!

17-02-2020 – Murray, A., Duncan, J., Glover, D., Griffin, S. A., Tarazi, A.


Background There you are, spending hours, days, months maybe even years on your research. You go ahead and publish it and alas! Those stress-filled seasons turn into a meagre 10 downloads. ‘No one gets how important this is!’ you cry. Let us at the British Journal of Sports Medicine (BJSM), prepare cushions around you and break it to you: it’s not them, it’s you! You expected a dopamine reward kick, but you have missed out because you’ve only done two-thirds of the work—the research part and the publish part. That last part is communicating your work. Why? Well, for you. It’s part of your personal growth- the more people your work reaches, the better engagement you’ll have1 2 and the better the discourse around your topic will be! We believe it’s your professional duty to get the word out in a way that works…

ICON 2019: International Scientific Tendinopathy Symposium Consensus: Clinical Terminology

17-02-2020 – Scott, A., Squier, K., Alfredson, H., Bahr, R., Cook, J. L., Coombes, B., de Vos, R.-J., Fu, S. N., Grimaldi, A., Lewis, J. S., Maffulli, N., Magnusson, S., Malliaras, P., Mc Auliffe, S., Oei, E. H. G., Purdam, C. R., Rees, J. D., Rio, E. K., Gravare Silbernagel, K., Speed, C., Weir, A., Wolf, J. M., Akker-Scheek, I. v. d., Vicenzino, B. T., Zwerver, J.

Journal Article

Background Persistent tendon pain that impairs function has inconsistent medical terms that can influence choice of treatment.1 When a person is told they have tendinopathy by clinician A or tendinitis by clinician B, they might feel confused or be alarmed at receiving what they might perceive as two different diagnoses. This may lead to loss of confidence in their health professional and likely adds to uncertainty if they were to search for information about their condition. Clear and uniform terminology also assists inter-professional communication. Inconsistency in terminology for painful tendon disorders is a problem at numerous anatomical sites. Historically, the term ‘tendinitis’ was first used to describe tendon pain, thickening and impaired function (). The term ‘tendinosis’ has also been used in a small number of publications, some of which were very influential.2 3 Subsequently, ‘tendinopathy’ emerged as the most common term…

Does adding hip exercises to quadriceps exercises result in superior outcomes in pain, function and quality of life for people with knee osteoarthritis? A systematic review and meta-analysis

17-02-2020 – Hislop, A. C., Collins, N. J., Tucker, K., Deasy, M., Semciw, A. I.

To determine, in people with knee osteoarthritis (KOA): i) the effectiveness of adding hip strengthening exercises to quadriceps exercises and ii) the type of hip strengthening exercise with the greatest evidence for improving pain, function and quality of life.
Systematic review with meta-analysis.
Data sources
Medline, Embase, Cochrane, CINAHL and Sport
Discus databases were searched from inception to January 2018.
Eligibility criteria for selecting studies
Randomised controlled trials investigating the effect of adding hip exercises to quadriceps exercises in people with KOA on pain, function and/or quality of life were included. Three subgroups of hip exercises were included: resistance, functional neuromuscular or multimodal exercise.
Eight studies were included. Pooled data provide evidence that combined hip and quadriceps exercise is significantly more effective than quadriceps exercise alone for improving walking function (standardised mean difference –1.06, 95% CI –2.01 to –0.12), but not for outcomes of pain (–0.09, 95% CI –0.96 to 0.79), patient-reported function (–0.74, 95% CI –1.56 to 0.08) or stair function (–0.7, 95% CI –1.67 to 0.26). Subgroup analyses reveal that hip resistance exercises are more effective than functional neuromuscular exercises for improving pain (p<0.0001) and patient-reported function (p<0.0001). Multimodal exercise is no more effective than quadriceps strengthening alone for pain (0.13, 95% CI –0.31 to 0.56), patient-reported function (–0.15, 95% CI –0.58 to 0.29) or stair function (0.13, 95% CI –0.3 to 0.57).
Walking improved after the addition of hip strengthening to quadriceps strengthening in people with KOA. The addition of resistance hip exercises to quadriceps resulted in greater improvements in patient-reported pain and function.

Aerobic exercise alleviates depressive symptoms in patients with a major non-communicable chronic disease: a systematic review and meta-analysis

17-02-2020 – Beland, M., Lavoie, K. L., Briand, S., White, U. J., Gemme, C., Bacon, S. L.

To assess whether aerobic exercise was superior to usual care in alleviating depressive symptoms in patients living with a major non-communicable disease.
Data sources
Data were obtained from online databases (PubMed, Psyc
INFO and SPORTDiscus) as well as from reference lists. The search and collection of eligible studies was conducted up to 18 October 2018 (PROSPERO registration number CRD42017069089).
Study selection
We included interventions that compared aerobic exercise with usual care in adults who reported depressive symptoms (ie, not necessarily the clinical diagnosis of depression) and were living with a major non-communicable disease.
Twenty-four studies were included in the meta-analysis (4111 patients). Aerobic exercise alleviated depressive symptoms better than did usual care (standardised mean difference (SMD)=0.50; 95% CI 0.25 to 0.76; Grading of Recommendations Assessment, Development and Evaluation: low quality). Aerobic exercise was particularly effective in alleviating depressive symptoms in cardiac patients (SMD=0.67; 95% CI 0.35 to 0.99).
Aerobic exercise alleviated depressive symptoms in patients living with a major non-communicable disease, particularly in cardiac populations. Whether aerobic exercise treats clinically diagnosed depression was outside the scope of this study.

Effectiveness of a school-based physical activity intervention on adiposity, fitness and blood pressure: MOVI-KIDS study

17-02-2020 – Martinez-Vizcaino, V., Pozuelo-Carrascosa, D. P., Garcia-Prieto, J. C., Cavero-Redondo, I., Solera-Martinez, M., Garrido-Miguel, M., Diez-Fernandez, A., Ruiz-Hermosa, A., Sanchez-Lopez, M.

To test a physical activity intervention (MOVI-KIDS) on obesity indicators, physical fitness and blood pressure (BP) in children.
A crossover randomised cluster trial was conducted, which comprised 1434 children (4–7 years old) from 21 schools in the provinces of Cuenca and Ciudad Real in the Castilla-La Mancha region of Spain. The intervention consisted of three 60 min sessions/week on weekdays between October 2013 and May 2014. Changes in anthropometric variables, physical fitness and BP parameters were measured. The analyses used were mixed regression models to adjust for baseline covariates under cluster randomisation.
There was no significant improvement in overweight/obesity with the intervention compared with the control group in both sexes. Further, the intervention did not alter other adiposity indicators or BP parameters. Improvements in cardiorespiratory fitness were seen in girls (1.19; 95% CI 0.31 to 2.08; p=0.008), but not in boys. Finally, there was an improvement in velocity/agility in both girls (–2.51 s; 95% CI –3.98 to –1.05; p=0.001) and boys (–2.35 s; 95% CI –3.71 to –0.98; p=0.001), and in muscular strength in both girls (0.66; 95% CI 0.03 to 1.28; p=0.038) and boys (1.26; 95% CI 0.03 to 1.28; p<0.001).
MOVI-KIDS was not successful in reducing the adiposity and maintained BP levels at previous healthy values in children. The intervention, however, showed significant improvements in cardiorespiratory fitness in girls, and muscular strength and velocity/agility in boys and girls.
Trial registration number NCT01971840; Post-results.

Anterior cruciate ligament (ACL) reconstruction and meniscal repair rates have both increased in the past 20 years in England: hospital statistics from 1997 to 2017

17-02-2020 – Abram, S. G. F., Price, A. J., Judge, A., Beard, D. J.

We investigated the temporal trend and the geographical variation in the rate of an anterior cruciate ligament (ACL) reconstruction and meniscal repair (MR) performed in England during a 20-year window.
All hospital episodes for patients undergoing ACL reconstruction or MR between 1 April 1997 and 31 March 2017 were extracted by procedure code from the national hospital episode statistics. Age-standardised and sex-standardised rates of surgery were calculated using Office for National Statistics population data as the denominator and analysed over time both nationally and regionally by National Health Service clinical commissioning group (CCG).
Between 1997–1998 and 2016–2017, there were 133 270 cases of ACL reconstruction (124 489 patients) and 42 651 cases of MR (41 120 patients) (isolated or simultaneous). Nationally, the rate of ACL reconstruction increased 12-fold from 2.0/100K population (95% CI 1.9 to 2.1) in 1997–1998 to 24.2/100K (95% CI 23.8 to 24.6) in 2016–2017. The rate of MR increased more than twofold from 3.0/100K (95% CI 2.8 to 3.1) in 1997–1998 to 7.3/100K (95% CI 7.1 to 7.5) in 2016–2017. Of these cases, the rate of simultaneous ACL reconstruction and MR was 2.6/100K (95% CI 2.5 to 2.8) in 2016/2017. In 2016–2017, for patients aged 20–29, the sex-standardised rate of ACL reconstruction was 76.9/100K (95% CI 74.9 to 78.9) and for MR was 19.8/100K (95% CI 18.8 to 20.9). Practice varied by region—in 2016–2017, 14.5% (30/207) of the CCGs performed more than twice the national average rate of ACL reconstruction and 15.0% (31/207) performed more than twice the national average rate of MR.
The rate of ACL reconstruction (12-fold) and MR (2.4-fold) has increased in England over the last two decades. There is variation in these rates across geographical regions and further work is required to deliver standardised treatment guidance for appropriate use.

High intensity exercise for 3 months reduces disease activity in axial spondyloarthritis (axSpA): a multicentre randomised trial of 100 patients

17-02-2020 – Sveaas, S. H., Bilberg, A., Berg, I. J., Provan, S. A., Rollefstad, S., Semb, A. G., Hagen, K. B., Johansen, M. W., Pedersen, E., Dagfinrud, H.

Exercise is considered important in the management of patients with rheumatic diseases, but the effect of high intensity exercises on disease activity is unknown.
To investigate the effectiveness of high intensity exercises on disease activity in patients with axial spondyloarthritis (ax
Assessor blinded multicentre randomised controlled trial. 100 patients (aged from their 20s to their 60s) with ax
A were randomly assigned to an exercise group or to a no-intervention control group. The exercise group performed cardiorespiratory and muscular strength exercises at high intensity over 3 months. The control group received standard care and was instructed to maintain their usual physical activity level. Primary outcome was disease activity measured with the Ankylosing Spondylitis (AS) Disease Activity Scale (ASDAS, higher score=worst) and the Bath AS Disease Activity Index (BASDAI, 0–10, 10=worst). Secondary outcomes were inflammatory markers, physical function and cardiovascular (CV)-health. There was patient involvement in the design and reporting of this study.
Results97 of the 100 (97%) randomised patients completed the measurements after the intervention. There was a significant treatment effect of the intervention on the primary outcome (ASDAS: –0.6 –0.8 to –0.3, p<0.001 and BASDAI: –1.2 –1.8 to –0.7, p<0.001). Significant treatment effects were also seen for inflammation, physical function and CV-health.
High intensity exercises reduced disease symptoms (pain, fatigue, stiffness) and also inflammation in patients with ax
A. It improves patients’ function and CV health. This debunks concerns that high intensity exercise might exacerbate disease activity in patients with ax
Trial registration number NCT02356874.

Infographic. New Zealand Rugbys concussion management pathway

17-02-2020 – Salmon, D., Romanchuk, J., Murphy, I., Sullivan, J., Walters, S., Whatman, C., Clacy, A., Keung, S., Van Der Vis, K.

Journal Article

Concussions in rugby union (rugby) impact not only player welfare but parental and players’ decisions around participation, a concern for rugby administrators around the world.1 2 To ensure player welfare, World Rugby has developed concussion management recommendations (; however, the practical application and enforcement of these recommendations presents a challenge.4 5 To address this challenge, New Zealand Rugby (NZR) as part of a National Concussion Initiative (infographic 1) developed a concussion management pathway (CMP) that considers the various stakeholders involved in the management of concussion as well as ways to support improved concussion management at the community level. The NZR CMP includes a Concussion Management Phone Application (App) and a web-based Concussion Portal for medical practitioners. The App allows the team lead (eg, physiotherapist, manager and parent) to complete the modified child SCAT5 baseline assessment during preseason…

Infographic. New Zealand rugbys community concussion initiative: keeping kiwi communities RugbySmart

17-02-2020 – Salmon, D., Sullivan, J., Romanchuk, J., Murphy, I., Walters, S., Whatman, C., Clacy, A., Keung, S., Van Der Vis, K.

Journal Article

Rugby union (rugby) is a popular full-contact team sport played by 8.5 million individuals in 121 countries across the globe ( In New Zealand (NZ), rugby is played by 157 218 individuals and engages all genders, ethnicities and socioeconomic diversities throughout the population. A key focus of both the international governing body of rugby (World Rugby) and NZ rugby (NZR) is the improvement of player welfare around common injuries such as concussion. Informed by the guidelines developed following the 2016 Berlin Concussion Consensus,1 World Rugby has developed policies and education programmes to standardise concussion management and promote player welfare ( Although these guidelines are intended to be implemented universally, the practical application of these recommendations in a community setting faces a number of challenges such as resource limitations, role multiplicity and inconsistent education. For example, in community rugby, 50%–70% of concussions go unreported<cross-ref…

Infographic. Strength training-induced adaptations associated with improved running economy: potential mechanisms and training recommendations

17-02-2020 – Lima, L. C. R., Blagrove, R.

Journal Article

Running economy (RE) is an important determinant of distance running performance that expresses running efficiency as the oxygen uptake necessary to sustain a fixed submaximal running speed.1 Many interventions have been proposed to improve RE (ie, reduce oxygen uptake), with strength training (ST) being one of the most frequently investigated training strategies.1 2 The literature indicates that 6 to 14 weeks of ST intervention is likely to improve RE, especially when it emphasises the development of maximal and explosive strength.1 While the impact of ST on RE is well established, the mechanisms that explain this phenomenon are still debated in the literature. The aim of the present infographic is to present plausible mechanisms underpinning improvements in RE following ST. In a recent review, Fletcher and Mac
Intosh3 presented several aspects of the neuromuscular system that may impact RE. In parallel systematic…

Infographic. Wake up and smell the coffee: caffeine supplementation and exercise performance

17-02-2020 – Grgic, J., Grgic, I., Pickering, C., Schoenfeld, B. J., Bishop, D. J., Virgile, A., Pedisic, Z.

Journal Article

Caffeine has been used as a performance-enhancing aid by athletes for many years. The first known study to explore the effects of caffeine ingestion on exercise performance dates back to 1907.1 Until recently, however, findings on this topic remained equivocal, despite a large number of published studies over the last 30 to 40 years.2 There are many possible reasons for the discrepant results between these studies, but one likely issue could be a common use of relatively small samples. To reconcile the equivocal evidence on this topic and overcome the low statistical power of individual studies, researchers have started to use meta-analytical methods. Meta-analysis is a statistical method that allows pooling of results from studies that address a similar research question.3 Given that meta-analytical findings may yield more conclusive statements than individual studies, the recent IOC consensus statement placed meta-analyses at the top…

Physical activity promotion in Australian physiotherapy practice: how do physiotherapists promote physical activity and what factors influence promotion? (PhD Academy Award)

17-02-2020 – Kunstler, B.

What did I do? My Ph
D comprised studies that identified: (1) the efficacy of physiotherapist-led physical activity (PA) interventions; (2) the behaviour change techniques (BCTs), or individual strategies, Australian physiotherapists use to promote PA to improve general health (non-treatment physical activity NTPA) and (3) the factors influencing their decision to promote NTPA.1–5 Why did I do it? Physiotherapists are expected to promote NTPA to increase the PA levels of patients to improve general health.6 It was important to establish if private practice and outpatient physiotherapists can successfully promote NTPA and the difficulties they face. How did I do it? I completed two systematic reviews that found physiotherapist-led NTPA interventions can increase patient PA levels in the short term only.1 Additionally, I found that physiotherapists use fewer BCTs when promoting NTPA…

Public health guidelines on sedentary behaviour are important and needed: a provisional benchmark is better than no benchmark at all

17-02-2020 – Chaput, J.-P., Olds, T., Tremblay, M. S.

The narrative review by Professor Stamatakis and colleagues1 published in the British Journal of Sports Medicine (BJSM) challenges the appropriateness of having quantitative public health guidelines on sedentary behaviour at this time. The authors argue that we still know little about the independent health effects of sitting, and the possibility that sitting is merely the inverse of physical activity remains. While we agree that many questions still need to be addressed in the field of sedentary behaviour research, we feel that providing quantitative recommendations on reducing sedentary behaviour is not premature, is needed, is low risk and is important for public health. Public health approaches to promoting healthy movement should be reconceptualised by considering the full 24-hour period (ie, sleep, sedentary behaviour and all physical activity) rather than focusing on individual behaviours or guidelines. Ignoring the compositional nature of these behaviours (they add up to 24 hours) is…

“When suspected runners colitis in a marathon runner turns out to be cancer-and in the end leads to a new personal best marathon time”

17-02-2020 – Steiner, P.

Journal Article

In the autumn of 2016, I completed my second marathon. I was an ambitious 35-year-old athlete, participating year-round in activities that included running, road cycling, triathlon and alpine skiing. I was fit and well, and apart from pollen allergies I had not had any medical treatment. Approximately 3 hours after the marathon, I developed my first episode of bloody diarrhoea. As a doctor, I suspected this to be runner’s colitis but was not overly concerned. I knew that a proportion of marathon runners report gastrointestinal complaints.1 Persisting symptom led to a worrisome diagnosis In the following days, my diarrhoea disappeared, but the blood in my stool persisted. Without any worrisome thoughts, I first underwent a proctoscopy which showed small haemorrhoids. These were treated, but because I still had blood in my stool I had a sigmoidoscopy a few weeks later. At this investigation, the gastroenterologist showed me…